ABSTRACT
Deficits in neurocognition in schizophrenia such as attention deficits, while recognized in earliest descriptions of the disorder, remain a largely overlooked facet of the illness not captured in current diagnostic systems. Consequently, such deficits are frequently neglected in clinical care. The impact of this neglect is particularly profound given the independence of neurocognitive deficits from other psychiatric symptoms associated with the disorder, resistance of these deficits to routine pharmacotherapy and their close link to functional outcome. Thus, the goal of this chapter is to provide an overview to understanding schizophrenia as a disorder of neurocognition as well as a disorder affecting mood and insight. This goal is approached by defining the schizophrenia syndrome, summarizing the relevant research identifying neurocognitive impairment as a core feature of the illness and the many ways in which this impairment may manifest, and then providing a description of emerging work on contemporary interventions for cognitive impairment in schizophrenia. More specifically, the chapter begins by defining the disorder in terms of its DSM-5 categorization, briefly reviewing epidemiology and etiology, then focusing on what is known about neurocognitive impairment in schizophrenia as related to the clinical course of illness from the premorbid period to first episode to chronic illness and then in senescence. The chapter evaluates the literature on the relationship of neurocognition to structural and functional neuroimaging studies, symptoms, and functioning in the disorder. Last, this chapter will summarize the treatment implications of a neurocognitive approach to schizophrenia, discussing promising pharmacologic and behavioral approaches to treatment that have emerged from a neurocognitive perspective on the disorder.
